Change creates the necessity for more change. Advances in medical technology, and the incentives of a fee-for-service insurance system, drove up the costs of care. In response, insurers and purchasers of care began to seek ways to control these increases in health care costs. Eventually, "managed care" organizations sprouted which combined both the delivery and financing of care to provide "cost-effective" care. This combination not only changed many doctors' incentives to provide care, but more broadly transformed the overall structure of the American health care market.